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1467269175 NPI number — RYAN JAMES WILKINSON LMSW

NPI Number: 1467269175
Health Care Provider/Practitioner: RYAN JAMES WILKINSON LMSW

Information about “1467269175” NPI (RYAN JAMES WILKINSON LMSW) exists in 1467269175 in HTML format HTML  |  1467269175 in plain Text format TXT  |  1467269175 in PDF (Portable Document Format) PDF  |  1467269175 in an XML format XML  formats.

NPI Number : 1467269175 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1467269175",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILKINSON",
    "FirstName": "RYAN",
    "MiddleName": "JAMES",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LMSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1275 N 400 E APT F",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RUPERT",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83350-8549",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "801-228-7082",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1275 N 400 E APT F",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RUPERT",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83350-8549",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "801-228-7082",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/16/2024",
    "LastUpdateDate": "12/16/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "CADC-5082",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "LMSW-45129",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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